A retrospective study in Japan assessed the efficacy and safety of anti-TNF treatment in bio-naïve elderly patients with inflammatory bowel disease (IBD). Elderly patients included were those 60 years and older, and grouped into two categories: first elderly with Elderly onset (EO) (Elderly-EO) and those with non-elderly onset (Elderly-NEO). 

In this multicenter observational trial, 432 bio-naive patients were enrolled, with 55 having Elderly-EO (12.7%), 25 having Elderly-NEO (5.8%), and 352 under the age of 60. (Non-elderly, 81.5 percent).

Clinical and steroid-free remission rates were significantly lower in elderly subjects with EO compared to non-elderly subjects after one year of anti-TNF treatment (37.7% and 60.8 percent, respectively; P 0.001 and 35.9% and 57.8%, respectively; P 0.003, respectively), and were comparable between NEO and non-NEO elderly. 

Multivariate analysis found that senile onset was a significant factor for both clinical remission (OR, 0.49, 95% CI 0.25-0.96) and steroid-free remission (OR, 0.51, 95% CI 0.26- 0.99) after 52 weeks of treatment with the anti-TNF therapeutic agent. The overall incidence of serious adverse events was significantly higher in geriatric-EO than in non-aged subjects and was consistent between geriatric-NEO and underage subjects.

The findings suggest that bio-naïve Elderly-EO IBD patients have a lower response to anti-TNF treatment compared with Non-elderly IBD patients. Patients with elderly-onset IBD who had Crohn′s disease, IBD for less than a year, and no concurrent corticosteroid usage were more likely to benefit from TNF inhibitor treatment in the long run. (MedPage Today April 1, 2022), Nature Scientific Reports, Sci Rep 2022; DOI: 10.1038/s41598-022-09455-8.